, Volume 23, Issue 1 Supplement, pp 7-12,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 19 Dec 2007

“That’s Like an Act of Suicide” Patients’ Attitudes Toward Deactivation of Implantable Defibrillators

Abstract

Objective

To understand potential patient barriers to discussions about implantable cardioverter defibrillator (ICD) deactivation in patients with advanced illness.

Design

Qualitative focus groups.

Participants

Fifteen community-dwelling, ambulatory patients with ICDs assigned to focus groups based on duration of time since implantation and whether they had ever received a shock from their device.

Approach

A physician and a social worker used a predetermined discussion guide to moderate the groups, and each session was audiotaped and subsequently transcribed. Transcripts were analyzed using the method of constant comparison.

Results

No participant had ever discussed deactivation with their physician nor knew that deactivation was an option. Patients expressed a great deal of anxiety about receiving shocks from their device. Participants discussed why they needed the device and expressed desire for more information about the device; however, they would not engage in conversations about deactivating the ICD. One patient described deactivation “like an act of suicide” and all patients believed that the device was exclusively beneficial. Patients also expressed a desire to have their physician make the decision about deactivation.

Conclusions

None of the patients in our study knew that they might need to deactivate their ICD as their health worsens. These community-dwelling outpatients were not willing to discuss the issue of ICD deactivation and their attitudes about deactivation might impede patients from engaging in these conversations. These findings are in contrast to findings in other advance care planning research and may be related to the unique nature of the ICD.

This research is support by Dr. Nathan Goldstein’s Hartford Geriatrics Health Outcomes Research Scholars Award, his Hartford Center of Excellence Scholar Award, and his Mentored Patient-oriented Research Career Development Award (1K23AG025933-01A1). Mr. Teitelbaum and Ms. Zeidman were supported by the American Federation for Aging Research Summer Medical Student Research Program. Dr. Bradley is supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation Investigator Award. Dr. Morrison is supported by a Midcareer Investigator Award in patient-oriented research award (1K24AG22345-01) from the National Institute on Aging and the National Palliative Care Research Center.